Fluid resuscitation of shock in children: what, whence and whither?

Excerpt

Infectious diseases remain a major cause of mortality and morbidity in the developed world, accounting for more than 25 % of deaths in children under the age of 5 years in Europe [1]. Even with improved recognition and management serious morbidity in survivors is high. As a pediatric critical care community we have often blamed inadequate fluid resuscitation for this finding, a consequence of failing to follow guidelines recommending aggressive fluid resuscitation, which we have seen as “acute medicine’s great triumph for children” [2]. In an article recently published in Intensive Care Medicine Bhaskar et al. [3] bring to our attention the problem of early fluid accumulation in children treated for shock and its association with pediatric intensive care unit (PICU) mortality. As a concept, intolerable excess of fluid and tissue storage by inundation, is not new—Walter Cannon introduced it at the same time as he defined homeostasis [4]—but it is worth reviewing the current article in the context of where we have come from and where we should be going with fluid management. …